Abstract
BackgroundNodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. There are no published reports of its association with Helicobacter pylori infection.MethodsFrom March 2005 till February 2010, we prospectively followed all patients with diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Patients underwent esophagogastroduodenoscopy with targeted biopsies, colonoscopy, and small bowel video capsule endoscopy. Duodenal nodular lesions were graded from 0 to 4 based on their size and density. Patients were screened for celiac sprue (IgA endomysial antibody), immunoglobulin abnormalities (immunoglobulin levels & serum protein electrophoresis), small intestine bacterial overgrowth (lactulose hydrogen breath test), and Helicobacter pylori infection (rapid urease test, and histological examination of gastric biopsies). Patients infected with Helicobacter pylori received sequential antibiotic therapy and eradication of infection was evaluated by 14C urea breath test. Follow up duodenoscopies with biopsies were performed to ascertain resolution of nodular lesions.ResultsForty patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years) with DDNLH were studied. Patients presented with epigastric pain, vomiting, and weight loss. Esophagogastroduodenoscopy showed diffuse nodular lesions (size varying from 2 to 5 mm or more) of varying grades (mean score ± 1SD 2.70 ± 0.84) involving postbulbar duodenum. Video capsule endoscopies revealed nodular disease exclusively limited to duodenum. None of the patients had immunoglobulin deficiency or small intestine bacterial overgrowth or positive IgA endomysial antibodies. All patients were infected with Helicobacter pylori infection. Sequential antibiotic therapy eradicated Helicobacter pylori infection in 26 patients. Follow up duodenoscopies in these patients showed significant reduction of duodenal nodular lesions score (2.69 ± 0.79 to 1.50 ± 1.10; p < 0.001). Nodular lesions showed complete resolution in 5 patients and significant resolution in remaining 21 patients. Patients with resistant Helicobacter pylori infection showed no significant reduction of nodular lesions score (2.71 ± 0.96 to 2.64 ± 1.15; p = 0.58). Nodules partially regressed in score in 2 patients, showed no interval change in 10 patients and progressed in 2 patients.ConclusionsWe report on a large cohort of patients with DDNLH, etiologically related to Helicobacter pylori infection.
Highlights
Nodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes
Another 2 patients had extensive disease involving duodenum, jejunum and ileum. These 2 patients had common variable immunodeficiency syndrome and one of them presented with superadded recurrent Giardia lamblia infection, Remaining 40 patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years; age range 14 to 62 years) had diffuse nodular disease limited to duodenum and formed the study group (Table 1)
All patients were infected with H. pylori infection
Summary
Nodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract represents a rare disease that is grossly characterized by the presence of numerous visible mucosal nodules measuring up to, and rarely exceeding, 0.5 cm in diameter [1]. There is an association with familial adenomatous polyposis and Gardner’s syndrome [20] It has been reported in patients with human immunodeficiency virus infection [21]. Except an isolated case of gastric nodular lymphoid hyperplasia, there are no published reports of association of NLH with Helicobacter pylori (H. pylori) infection [23]. We report on a large cohort of patients with NLH, etiologically related to H. pylori infection
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